Individual provider Active NPI

Michael Scott Kelley, MD

  • Anesthesiology Physician
  • Washington, DC
National Provider Identifier
1306930219
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
8949 Issued in NH
Practice address
6900 Georgia Ave NW
Building 2, 4TH Floor, Dept of Anesthesia
Washington, DC 20307-0003
Phone
(202) 782-2940
Fax
(202) 782-5065
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 8949 NH Primary

Addresses

Primary practice location

6900 Georgia Ave NW
Building 2, 4TH Floor, Dept of Anesthesia
Washington, DC 20307-0003

Mailing address

392 Ironwood CT
Millersville, MD 21108-1869
Phone (410) 729-2828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070109000186 MN Practitioner - Anesthesiology 7517967987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Geisel School of Medicine at Dartmouth, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southdale Anesthesiologists LLCGroup PAC ID 6709842461, 62 clinicians

Practice addresses (Care Compare)

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
8949NHMDAnesthesiology Physician
102819MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southdale Anesthesiologists, LLC Anesthesiology CurrentSince Jan 2, 2007 Accepting new patients

Locations

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306930219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "392 IRONWOOD CT",
            "city": "MILLERSVILLE",
            "state": "MD",
            "postal_code": "211081869",
            "telephone_number": "410-729-2828",
            "fax_number": "202-782-5065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 GEORGIA AVE NW",
            "address_2": "BUILDING 2, 4TH FLOOR, DEPT OF ANESTHESIA",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "203070003",
            "telephone_number": "202-782-2940",
            "fax_number": "202-782-5065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NH",
            "license": "8949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.